Barriers and facilitators to participation in breast, bowel and cervical cancer screening in rural Victoria: A qualitative study.

ISSUE ADDRESSED: Population cancer screening rates are around 50% for the general population and even lower in rural areas. This study aimed to explore knowledge, attitudes, behaviours, motivators and barriers to breast, bowel and cervical screening participation in under-screened men and women. METHODS: We used a qualitative research design. Focus groups were segmented by age, sex and screening participation. Participants were under-screened in at least one of the cancer screening programs, with separate groups for each of the programs. The discussion guides were designed around the Health Belief Model and group discussions were coded using a thematic content analysis approach. RESULTS: Fourteen focus groups were held with 80 participants. Key themes were that the concept of cancer screening was not well understood, a low priority for preventive health behaviours, issues relating to local general practitioners (GP) and screening was unpleasant, embarrassing and/or inconvenient. A key determinant of participation in cancer screening was exposure to prompts to action, and it was evident that participants often required multiple prompts before they took action. CONCLUSIONS: Opportunities that develop attitudes to health that place disease prevention as a high priority; improve understanding of the benefit of screening in terms of early detection and treatment; improve GP availability and the patient-practitioner relationship; and the development of messages for each of the screening programs should be further explored as factors that may influence rural population screening rates. SO WHAT?: Addressing health attitudes, beliefs, knowledge, health practitioner and test-related barriers and improving messaging may increase cancer screening participation in under-screened rural populations.

Responding to COVID-19 with real-time general practice data in Australia.

INTRODUCTION: As SARS-CoV-2 spread around the world, Australia was no exception. Part of the Australian response was a robust primary care approach, involving changes to care models (including telehealth) and the widespread use of data to inform the changes. This paper outlines how a large primary care database responded to provide real-time data to inform policy and practice. Simply extracting the data is not sufficient. Understanding the data is. The POpulation Level Analysis and Reporting (POLAR) program is designed to use GP data for multiple objectives and is built on a pre-existing engagement framework established over a fifteen-year period. Initially developed to provide QA activities for general practices and population level data for General Practice support organisations, the POLAR platform has demonstrated the critical ability to design and deploy real-time data analytics solutions during the COVID-19 pandemic for a variety of stakeholders including state and federal government agencies. METHODS: The system extracts and processes data from over 1,300 general practices daily. Data is de-identified at the point of collection and encrypted before transfer. Data cleaning for analysis uses a variety of techniques, including Natural Language Processing and coding of free text information. The curated dataset is then distilled into several analytic solutions designed to address specific areas of investigation of interest to various stakeholders. One such analytic solution was a model we created that used multiple data inputs to rank patient geographic areas by the likelihood of a COVID-19 outbreak. The model utilised pathology ordering, COVID-19 related diagnoses, indication of COVID-19 related concern (via progress notes) and also incorporated state based actual confirmed case figures. RESULTS: Using the methods described, we were able to deliver real-time data feeds to practices, Primary Health Networks (PHN) and other agencies. In addition, we developed a COVID-19 geographic risk stratification based on local government areas (LGAs) to pro-actively inform the primary care response. Providing PHNs with a list of geographic priority hotspots allowed for better targeting and response of Personal Protective Equipment allocation and pop-up clinic placement. CONCLUSIONS: The program summarised here demonstrates the ability of a well-designed system underpinned by accurate and reliable data, to respond in real-time to a rapidly evolving public health emergency in a way which supports and enhances the health system response.

COVID-19: protocol for observational studies utilizing near real-time electronic Australian general practice data to promote effective care and best-practice policy-a design thinking approach.

BACKGROUND: Health systems around the world have been forced to make choices about how to prioritize care, manage infection control and maintain reserve capacity for future disease outbreaks. Primary healthcare has moved into the front line as COVID-19 testing transitions from hospitals to multiple providers, where tracking testing behaviours can be fragmented and delayed. Pooled general practice data are a valuable resource which can be used to inform population and individual care decision-making. This project aims to examine the feasibility of using near real-time electronic general practice data to promote effective care and best-practice policy. METHODS: The project will utilize a design thinking approach involving all collaborators (primary health networks [PHNs], general practices, consumer groups, researchers, and digital health developers, pathology professionals) to enhance the development of meaningful and translational project outcomes. The project will be based on a series of observational studies utilizing near real-time electronic general practice data from a secure and comprehensive digital health platform [POpulation Level Analysis and Reporting (POLAR) general practice data warehouse]. The study will be carried out over 1.5 years (July 2020-December 2021) using data from over 450 general practices within three Victorian PHNs and Gippsland PHN, Eastern Melbourne PHN and South Eastern Melbourne PHN, supplemented by data from consenting general practices from two PHNs in New South Wales, Central and Eastern Sydney PHN and South Western Sydney PHN. DISCUSSION: The project will be developed using a design thinking approach, leading to the building of a meaningful near real-time COVID-19 geospatial reporting framework and dashboard for decision-makers at community, state and nationwide levels, to identify and monitor emerging trends and the impact of interventions/policy decisions. This will integrate timely evidence about the impact of the COVID-19 pandemic related to its diagnosis and treatment, and its impact across clinical, population and general practice levels.

Youth access clinics in Gippsland: Barriers and enablers to service accessibility in rural settings.

AIM: Approximately 15 years ago, four youth access clinics (YACs) were established in the Gippsland region to improve mental and general healthcare for young people living in the region. The aim of the study was to examine the barriers and enablers for young people accessing the YACs in Gippsland. METHODS: Using qualitative methodology, nine female YAC staff members and seven youth YAC consumers were interviewed. Thematic analysis was utilized to identify important and consistent themes in the data derived through the consultation process. RESULTS: Barriers under four themes were identified: environmental (eg, limited transport); service (ie, limited opening hours); client (eg, parent permission) and staff (ie, retention of staff). Enablers were identified as environmental (ie, high social proximity), service (eg, funding), client (ie, awareness of service) and staff (eg, champion staff). CONCLUSION: The success of new rural service models will likely depend on learning from what has already worked in some of the many small communities in this region. Beyond learning, further success and uptake of new service offerings will be enhanced through understanding community needs, obtaining community support and enhancing high social proximity.